This pilot project will help us understand the epidemiology and pathogenesis of urinary tract infections among institutionalized, geriatric patients. In the initial phase of the proposal, we will delineate risk factors and other determinants that predispose these patients to urinary infections. During this phase of our studies, we will identify modes of transmission of bacteria within the nursing home setting. In addition, we will evaluate the importance of urethral and urinary colonization as predisposing factors to symptomatic infection. Finally, we will determine the influence of host factors that predispose to infection. These studies will enable us to identify risk factors that may be alterable and will direct us to effective methods for infection prevention. The ultimate goal of this series of projects is to reduce the incidence of urinary tract infections in nursing home patients by specific preventive or therapeutic interventions. We will design studies to evaluate methods to break the chain of transmission or decrease the likelihood of symptomatic infection for these patients. Our studies will involve both non-catheterized patients and patients with chronic, indwelling urinary catheters. In both groups, interventions will be evaluated to determine the best methods for preventing infection. These studies will enable us to develop guidelines for the prevention of urinary tract infections in this patient population.